Leading PersonCentered Care in a Health Ministry

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Leading Person-Centered Carein a Health Ministry

We dance round in a ring and suppose, But the
secret sits in the middle knows
Robert Frost
Milt Hammerly, MD Marita Schifalacqua, RN Jeanie
Mamula, CPHQ 6-18-07
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Objectives

• To understand the principles and rationale for
  person-centered care
• To highlight examples of person-centered care in
  different settings across the continuum
• To identify three steps I can take as a leader to
  make services at my facility more person-centered

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CHI.. Who we are..
(June, 2007)
New Jersey
May, 1996
3 Catholic Health Systems sponsored by
10 congregations consolidated to
form CHI
Now serving in 20 states

Approx. 70,000 employees

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Hospitals (19 CAH), 43 Continuum facilities, 2
Community Health Orgs
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CHI Mission Vision Values

• MISSION
• To nurture the healing ministry of the Church by
  bringing it new life, energy and viability in the
  21st century. Fidelity to the Gospel urges us to
  emphasize human dignity and social justice as we
  move toward the creation of healthier
  communities.

• VISION
• Catholic Health Initiatives vision is to live
  out its mission by transforming health care
  delivery and by creating new ministries for the
  promotion of healthy communities
• CORE VALUES
• Reverence
• Integrity
• Compassion
• Excellence
• .

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CHI Principles of Person-Centered Care (PCC)

• A philosophy of caring that is
• Personalized by design
• Individualized according to patient values,
  needs, values and desires
• Comprehensive in scope
• Attending to the whole person Body, Mind and
  Spirit
• Delivered through Collaborative partnerships
• Partnerships with patients, families, providers
  and community stakeholders made possible by
  transparent communication

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Patient vs. Person-Centered

• Patient
• Relationship healthcare providers / system
  (Patient dependent)
• Focus fixing pathology
• Process design institution/providers

• Person
• Relationship patient values, preferences
  needs (Patient locus of control)
• Focus body, mind, spirit
• Process design person in need (how s/he wants to
  be treated)

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Person Centered Care (PCC) Journey

• History
• Integrative medicine ? Patient Centered Care
  ? Person-Centered Care
• Clinical quality focus area in 2005
• PCC national resources experts identified
• Internal experts leading practices identified
• PCC committee created

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PCC Journey

• Action Plan
• Develop educational material
• Q A
• National resources
• Business case
• Survey.. Staff patients
• Senior Leadership Engagement
• Too philosophical ? Push for being concrete
• Incorporated into strategic plan

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PCC Vision CHI Strategic Plan 2007 - 2011
Four Core Strategies People, Quality,
Stewardship, and Growth CHI will be
distinguished by
-Innovative partnerships with our patients,
our physicians, payers, and others
that encourage and reward
effective, new models of
person-centered care


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PCC Journey

• CHI National Leadership Conference
• PCC presentation video showcasing leading
  practices
• Connect with Rosemary Gibson
• Strategic planning ..
• Multidisciplinary. clinical non-clinical

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PCC Journey

• INTEGRATION into all we do
• Leadership formation Leadership That Shapes the
  Future
• Transparency Price, Errors, Core Measures
• Internal Conferences and meetings
• Breakout sessions,
• Patient reflection/Sacred Stories
• Master Facility Planning culture processes,
  bricks mortar
• Patient Safety
• Rapid response teams (RRT)-Patient/Family
  activation,
• Medication Administration, Infection Control
• Patient Experience (Hospital Consumer Assessment
  of Healthcare Providers and Systems HCAHPS )
• Patient participation in committees (IHI
  mini-collaborative)

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Alignment of Person-Centered Care

• Locally driven pilots
• Early
• Medical/Surgical
• Long Term Care (LTC)
• Ambulatory disease/wellness mgmt
• Current
• Orthopedics
• Emergency Department
• Employee health benefit pilot
• Master Facility Planning (MFP)

• St. Elizabeth, Lincoln, NE
• Franciscan Villa, Milwaukee, WI
• Mercy Clinics, Des Moines, IA
• Good Samaritan, Kearney, NE
• St. Elizabeth, Baker City, OR
• St Vincent, Little Rock, AR
• Memorial, Chattanooga, TN
• St. Josephs, Lexington, KY
• Marymount, London, KY
• St. Francis, Grand Island, NE

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The POWER of ONE

• How can we improve the patient experience?
• one person,
• one provider,
• one interaction at a time?

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Video.. Role of Leadership in PCC
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Person-Centered Care

• Example Success Stories

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LTC Success Story at Franciscan Villas in
Milwaukee, WI

• Leadership
• Visible buy-in by Administrator, Director of
  Nursing
• LEAP Training, beginning with supervisors
• Nursing Assistants Mentor Training
• Residents/Families
• Studied sleep, eating patterns
• Devised new meal schedules
• Changed breakfast routines to resident preference
• Reviewed recent resident/family satisfaction
  surveys to pick potential areas of focus
• Kept families informed, asked for input on
  resident needs.
• Staff
• Surveyed staff for readiness for PCC
• Changed schedules to meet residents needs
• Changed duties
• Additional education

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Violas Story
Viola before Kept to herself, did not
initiate conversation Occasional one word
response Appeared very demented and stoic
without much expression Severely contracted
hands, made no attempts to feed herself Slowly
losing weight
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• Viola afterThis is the best oatmeal I have
  ever eaten.
• Initiates conversation with staff and
  peersAble to drink from a cup Weight has
  stabilizedEven more amazing she is now able to
  walk She smiles more and appears happierHer
  smile warms the room

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Acute Care Success Story at St. Elizabeths in
Lincoln

• Patient Staff survey
• Data presented
• Patient Advisory Council
• Multidisciplinary Care Coordinating Council
• Focus opportunity
• Family Involvement
• Preparation for home management
• Intervention
• ? Admission assessment

• RESULTS
• Statistically significant
• Didnt cost
• Process change

Perfect Care Top
Performance Opportunities
Post
Performance Score
Post
56
53
Pre
Pre
N38
N33
N38
N33
Were treatment costs discussed?
Did hospital experience prepare you to better
manage condition at home?
Did providers ask how much you want family
members involved in your care?
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Clinic Survey Results
Bold text Importance is significant at 95 C.I.
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1. Treat as a Whole Person

• The clinics that consistently did the best on
  experience scores were the first to use Health
  Coaches
• Maintain disease registry
• Contact patients proactively
• Provide Self-Management Support
• Behavioral more than education approach
• Identify behavior change that is important to the
  patient
• Increase the patients confidence that the change
  is possible
• Follow-up between appointments
• Reference Health Behavior Change by Stephen
  Rollnich

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2. Safest Care Provided

• Safety is a system property. Patients should be
  safe from injury caused by the care system.
  Reducing risk and ensuring safety require greater
  attention to systems that help prevent and
  mitigate errors. Institute of Medicine,
  Redesign Rule 6.
• Standardization Concepts
• We are not trying for perfection
• Start with a process thats 80 effective and
  then improve
• Cant use process improvement if you dont have a
  process to improve
• Test a small segment of the process
• If this doesnt work, a larger segment wont work
  either
• Use PDSA (Plan, Do, Study, Act) cycles to improve
• Repeat cycles rapidly (can be as little as one
  day)

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Greatest Risks to Patient Safety in Ambulatory
Care
Source MGMA Connexion Jan. 2006
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3. Access to Lab Results

• Often poorly done with no standard process
• High risk for patient injury malpractice claims
• Often every doctor in a clinic has a different
  policy
• Every lab should be logged out, in, and when
  patient is notified of result
• Notifying only if abnormal is unacceptable

• Process standardized
• Every clinic uses same process
• Calls on all tests, not just abnormals

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Quality
Two Equally Important Perspectives
Providers
Patients/Families
The degree to which health services for
individuals and populations increase the
likelihood of desired health outcomes and are
consistent with current professional
knowledge. The Institute of Medicine
The degree to which I am treated respectfully as
a whole person (rather than a condition),
determines my experience. My individual needs are
anticipated and responded to, and I have control
over the situation. (Evidence-based care is
expected)
Measures quantitative
Measures qualitative quantitative
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We Seek to Provide the
Patients Want to Receive
Right care Right amount Right way Right
place Right time Right cost AND,
BE ABLE TO PROVE IT
The best care, Their way AND,
BE ABLE TO FEEL IT
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Reaching the Vision Perspectives

• Providers Think STEEEP
• Care that is always
• Safe free from injury or harm
• Timely without unnecessary delays
• Effective evidence based
• Efficient eliminates waste
• Equitable just care for all
• Person-Centered
  nothing about me without me

• Patients Think STEEEP
• Care that is always
• Safe free from injury or harm
• Timely without unnecessary delays
• Effective evidence based
• Efficient eliminates waste
• Equitable just care for all
• Person-Centered
  nothing about me without me

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Guiding Principles
balance

• Provider Principles
• Reduce unnecessary variation
• Transparent bilateral communication
• Collaborative decision making
• Implement the decisions made
• Leadership

• Patient Principles
• Ensure necessary customization
• Transparent bilateral communication
• Collaborative decision making
• Implement the decisions made
• Leadership

leverage
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Measuring PCC Progress Across CHI

• FUTURE
• HCAHPS
  Hospital Consumer Assessment Health Plans
• Patient Experience Survey
• Centers for Medicare and Medicaid Services
• Transparency
• Price
• Ministry Formation
• Leadership development

• CURRENT
• Focused PCC survey.. Staff patients
• Action plan from results
• Rapid Response Team.. Family initiated..
• 3 facilities today
• Core Measures
• movement to Perfect care
• National Pharmacy Team
• patient advocate

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Four Measures

• Outcome metric
• Process metric
• Structure metric
• Person Centered Care metric

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What Can I Do As A Leader?

• Learn more about Person-Centered Care
• Engage senior leadership
• Identify champions
• In existing activities and services, ask how it
  could be more Personalized, Comprehensive and
  Collaborative?
• Invite patient participation in advisory councils
  and process improvement committees
• Invite patients to offer reflections at meetings
• Identify and act on measures that matter to
  patients

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video